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DGH v Tertiary Intervention – Is there really a conflict ?. Steven Lindsay Bradford Teaching Hospitals NHS Trust. Conflict of Interest I am a “DGH” interventionalist. Bradford. History lesson. Cardiology in Bradford in 1999. 1000 bedded DGH 400,000 population

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Dgh v tertiary intervention is there really a conflict

DGH v Tertiary Intervention – Is there really a conflict?

Steven LindsayBradford Teaching Hospitals NHS Trust


Conflict of Interest

I am a “DGH” interventionalist




Cardiology in bradford in 1999
Cardiology in Bradford in 1999

  • 1000 bedded DGH

  • 400,000 population

  • 2 cardiologists -non interventional

  • 2 diagnostic angio sessions in multipurpose lab




How to get from here1

to here

How to get from here……

1708

1708

1708


Cardiac labs in west yorkshire 1999
Cardiac Labs in West Yorkshire 1999

  • 9 DGH labs – most multi purpose

  • All PCI in Leeds (3 cardiac labs open)

  • 4 Tertiary Centre Interventionalists

  • 7 DGH visitors


Cardiology in bradford in 2000
Cardiology in Bradford in 2000

  • 1000 bedded DGH

  • 400,000 population

  • 3 cardiologists -1 interventional

  • 2 diagnostic angio sessions in multipurpose lab

  • 1 diagnostic session in Airedale

  • 1 PCI session in tertiary centre


Cardiology in bradford in 2001
Cardiology in Bradford in 2001

  • 1000 bedded Teaching Hospital

  • 400,000 population

  • 3 cardiologists -1 interventional

  • 2 diagnostic angio sessions in multipurpose lab

  • 1 diagnostic session in Airedale

  • 1 PCI session in tertiary centre

  • 9 month waiting list for PCI


Cardiology in bradford in 2002
Cardiology in Bradford in 2002

  • 1000 bedded Teaching Hospital

  • 400,000 population

  • 3 cardiologists -1 interventional

  • 1 Associate Specialist

  • Dedicated cardiac lab

  • 2nd Interventional post approved

  • 2 PCI session in tertiary centre


Pci in west yorkshire 2002
PCI in West Yorkshire 2002

  • 2002/2003 total PCI activity in Leeds 1691 cases

  • NSF targets of 750 pmp by 2004/2005= 2380 cases

  • Airedale PCI activity corrected for SMR is 1157 pmp (equivalent to 5000 PCIs p.a. across the WYNCC).

  • But where is the extra capacity?


Bradford
Bradford

  • NSF targets = 370 cases pa for the 3 Bradford PCTs.

  • The Bradford “patch” is sufficiently large to support a stand-alone PCI service and more than satisfy the BCIS requirements for a minimum of 200 cases p.a. and individual operator caseloads of at least 75 cases p.a.

  • 3 vacant lab sessions are available for PCI.

  • 3 cases per session and working year of 40 weeks = 360 cases p.a.

  • Retain one session for “high risk” cases and adjunctive technologies (IVUS, rotablator, presssure wire)

  • Release one session in Leeds -a further 120 cases can be carried out.

  • Network capacity increased by 480 cases


What we actually did
What we actually did

  • Jan 05 started with 1 acute session in Bradford

  • April 2005 1 elective session in Bradford

  • All Bradford PCI sessions in am

  • Not a 24/7 service

  • Out of Hours cover from Leeds (never utilised)

  • May 2006 Bradford Interventionalists occupy 1 slot on W York's PPCI rota in Leeds


Bradford interventional activity 2005 2007
Bradford Interventional activity 2005-2007

  • 453 at LGI Jan 05 to Jan 07

  • 349 at BRI Jan 05 to Jan 07

  • 2 operators

    • 3 lists/wk at BRI

    • Ad hoc acute activity during working week

    • 2 lists/wk (1 all day list) at LGI



Thankyou
Thankyou

  • West Yorkshire Network

  • Jim McLenachan and Stacey Hunter LTHT

  • Chris Durkin BTHT

  • John Kurian BTHT


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